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ncds_69_pq
STRICTLY CONFIDENTIAL
PARENTAL INTERVIEW FORM
NATIONAL CHILD DEVELOPMENT STUDY
(1958 Cohort)
SPONSORED AND ADMINISTERED BY: National Bureau for Co-operation in Child Care
CO-SPONSORED BY: Institute of Child Health, University of London National Birthday Trust Fund National Foundation for Educational Research in England and Wales
IN COLLABORATION WITH: ENGLAND AND WALES Association of Chief Education Officers Society of Medical Officers of Health SCOTLAND Association of Directors of Education Association of School Medical and Dental Officers
CHAIRMAN OF CONSULTATIVE COMMITTEE: Mary D. Sheridan, O.B.E., M.A., M.D., D.C.H.
CHAIRMAN OF STEERING COMMITTEE: W.D. Wall, B.A., PH.D.
EXECUTIVE CO-DIRECTORS: Professor N. R. Butler, M.D., F.R.C.P., D.C.H. Mrs M. L. Kellmer Pringle B.A., PH.D., DIP.ED.PSYCH.
CO-DIRECTOR AND PRINCIPAL INVESTIGATOR: R. Davie, B.A., DIP.ED.PSYCH.
CO-DIRECTORS: M. J. R. Healy, B.A. J. M. Tanner, M.D., D.SC., M.R.C.P. W. D. Wall, B.A., PH.D.
SENIOR RESEARCH OFFICER: P. J. Wedge, M.A., DIP.PUB.SOC.ADMIN., DIP.APP.SOC.STUD.
SECOND FOLLOW-UP OF CHILDREN

CHILD'S NAME (Surname)

Generic text

CHILD'S NAME (Christian names)

Generic text

CHILD'S SEX (Please ring appropriate number)

1
Boy
2
Girl

TODAY'S DATE

Generic date

DATE OF CHILD'S BIRTH

Date of birth

CHILD'S PRESENT HOME ADDRESS

Generic text

CHILD'S HOME ADDRESS AT TIME OF BIRTH

Generic text

PLACE OF BIRTH IF DIFFERENT FROM ABOVE

Generic text

CHILD'S HOME ADDRESS AT THE TIME OF FIRST FOLLOW-UP (AGED SEVEN)

Generic text
IF BORN ABROAD,

please give approximate date child came to live in this country

Generic date

NAME OF INTERVIEWER

Generic text

NAME OF INFORMANT (Surname)

Generic text

NAME OF INFORMANT (Christian names)

Generic text

RELATIONSHIP OF INFORMANT TO THE STUDY CHILD

1
Mother (or Mother Substitute)
2
Other (please specify)
Other
* PLEASE READ THE INTRODUCTORY NOTES OVERLEAF ON PAGE 2
PEOPLE IN THE HOUSEHOLD
A household comprises the group of persons living together partaking of meals prepared together and benefiting from a common housekeeping.
Who normally lives in the Study child's household? Exclude any children or others who are only at home for short periods, for example, school holidays.
Relationship to Study Child (e.g. Father, Stepbrother) or Status in Household (e.g. Lodger). Roster cs_q10_a_X Generic text Age Generic text Generic text Age Generic text Age Generic text Generic text
Study Child 1 Surname
Study Child 1 Christian Name
Study Child 1 Age (in years)
Study Child 2 Surname
Study Child 2 Christian Name
Study Child 2 Age (in years)
Study Child 3 Surname
Study Child 3 Christian Name
Study Child 3 Age (in years)
Study Child 4 Surname
Study Child 4 Christian Name
Study Child 4 Age (in years)
Study Child 5 Surname
Study Child 5 Christian Name
Study Child 5 Age (in years)
Study Child 6 Surname
Study Child 6 Christian Name
Study Child 6 Age (in years)
Study Child 7 Surname
Study Child 7 Christian Name
Study Child 7 Age (in years)
Study Child 8 Surname
Study Child 8 Christian Name
Study Child 8 Age (in years)
List below, any member of the family (under the age of 21 years) not included in the above table, for example those who are only home for holidays or leave, and enquire or state from your own knowledge the reason for absence, for example, at residential special school, or working away.
Relationship to Study Child Surname Christian Name Age (in years) Reason for Absence from Home
Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text
1
2
3
4
Enter the following details of any children born to the Study child's OWN MOTHER subsequent to the Study child. Include both members of twin pairs separately and omit miscarriages.
NAME Roster cs_q10_c_X Ounces in pound cs_q10_c_i Date of birth cs_q10_c_ii Pounds Ounces in pound Pounds cs_q10_c_ii Date of birth cs_q10_c_i Pounds cs_q10_c_i cs_q10_c_ii Ounces in pound Date of birth Date of birth cs_q10_c_i Ounces in pound Pounds cs_q10_c_ii Pounds Ounces in pound cs_q10_c_i Date of birth cs_q10_c_ii

1 - Male

2 - Female

3 - Alive now

4 - Stillbirth

5 - Died subsequently

3 - Alive now

4 - Stillbirth

5 - Died subsequently

1 - Male

2 - Female

1 - Male

2 - Female

3 - Alive now

4 - Stillbirth

5 - Died subsequently

1 - Male

2 - Female

3 - Alive now

4 - Stillbirth

5 - Died subsequently

1 - Male

2 - Female

3 - Alive now

4 - Stillbirth

5 - Died subsequently

Study Child 1 DATE OF BIRTH
Study Child 1 SEX
Study Child 1 SURVIVAL
Study Child 1 BIRTH WEIGHT (Approx. if necessary lbs
Study Child 1 BIRTH WEIGHT (Approx. if necessary ozs
Study Child 2 DATE OF BIRTH
Study Child 2 SEX
Study Child 2 SURVIVAL
Study Child 2 BIRTH WEIGHT (Approx. if necessary lbs
Study Child 2 BIRTH WEIGHT (Approx. if necessary ozs
Study Child 3 DATE OF BIRTH
Study Child 3 SEX
Study Child 3 SURVIVAL
Study Child 3 BIRTH WEIGHT (Approx. if necessary lbs
Study Child 3 BIRTH WEIGHT (Approx. if necessary ozs
Study Child 4 DATE OF BIRTH
Study Child 4 SEX
Study Child 4 SURVIVAL
Study Child 4 BIRTH WEIGHT (Approx. if necessary lbs
Study Child 4 BIRTH WEIGHT (Approx. if necessary ozs
Study Child 5 DATE OF BIRTH
Study Child 5 SEX
Study Child 5 SURVIVAL
Study Child 5 BIRTH WEIGHT (Approx. if necessary lbs
Study Child 5 BIRTH WEIGHT (Approx. if necessary ozs
Study Child 6 DATE OF BIRTH
Study Child 6 SEX
Study Child 6 SURVIVAL
Study Child 6 BIRTH WEIGHT (Approx. if necessary lbs
Study Child 6 BIRTH WEIGHT (Approx. if necessary ozs
Study Child 7 DATE OF BIRTH
Study Child 7 SEX
Study Child 7 SURVIVAL
Study Child 7 BIRTH WEIGHT (Approx. if necessary lbs
Study Child 7 BIRTH WEIGHT (Approx. if necessary ozs

Please enter the following information in respect of any deceased child of the Study child's own mother. Include children born before and after the Study child. the age at death ... years ... months

Age
Months

Please enter the following information in respect of any deceased child of the Study child's own mother. Include children born before and after the Study child. the cause of death

Generic text

Was the Study child's birth single or multiple?

1
Single
2
Multiple
3
Don't know

The actual relationship to the Study child of the persons acting as the child's parents is: (Please ring as appropriate) MOTHER

1
Own (or natural) mother
2
Mother by legal adoption
3
Step-mother
4
Foster-mother
5
Grandmother
6
Elder sister
7
No mother figure
8
Other (please specify)
Other
If neither 1 nor 2 is ringed please state (if possible)
qc_11_i != 1 && qc_11_i != 2

why child is not living with his/her own or adoptive mother.

Generic text

at what age child came under the care of present mother-substitute. State age in box, e.g. 6 yrs = 06 10 yrs = 10

Age

The actual relationship to the Study child of the persons acting as the child's parents is: (Please ring as appropriate) FATHER

1
Own (or natural) father
2
Father by legal adoption
3
Step-father
4
Foster-father
5
Grandfather
6
Elder brother
7
No father figure
8
Other (please specify)
Other
If neither 1 nor 2 is ringed please state (if possible)
qc_11_ii != 1 && qc_11_ii != 2

why child is not living with his/her own or adoptive father.

Generic text

at what age child came under the care of present father-substitute. State age in box, e.g. 6 yrs = 06 10 yrs = 10

Age

Has the child been looked after for more than one month by any mother-figure other than the one indicated in Question 11. (Exclude hospital admissions and boarding school attendance.)

1
Yes
2
No
3
Don't know

Has this child ever been in the care of a Local Authority Children's Committee?

1
Yes, in care now
2
Yes, in care only in the past
3
No, has never been in care
4
Don't know
5
Other reply (give details)
Other
If yes,
qc_12_b == 1 || qc_12_b == 2

what was child's age at the time of admission to care (or at the last time of admission if more than one) and the name of the Local Authority. Age

Age

what was child's age at the time of admission to care (or at the last time of admission if more than one) and the name of the Local Authority. Name of Local Authority

Generic text

Has the child ever been in the care of a Voluntary Society?

1
Yes, in care now
2
Yes, in care only in the past
3
No, has never been in care
4
Don't know
5
Other reply (give details)
Other
If yes,
qc_12_c == 1 || qc_12_c == 2

what was the child's age at the time of admission to care (at the last time of admission if more than one) and the name of the Voluntary Society. Age

Age

what was the child's age at the time of admission to care (at the last time of admission if more than one) and the name of the Voluntary Society. Name of Voluntary Society

Generic text

How many schools has the child attended since the age of 5 years, not counting moves from one department to another of the same school. Write the actual number in the box, and if 9 or more enter 9. If answer is not straightforward, give details

How many
Generic text

Read this to the parent: 'Would you like ... (child's name) to leave school as soon as possible or stay on longer?'

1
Leave as soon as possible
2
Stay on longer
3
Don't know yet

Read this to the parent: 'Do you hope that after leaving school ... (child's name) will undertake further training or education (full-time or part-time)?'

1
Yes
2
No
3
Don't know yet

Read this to the mother: 'How satisfied are you with play amenities for ... (child's name) within about 10-15 minutes walk of here?'

1
Very satisfied
2
Fairly satisfied
3
No feelings either way
4
Rather unsatisfied
5
Very unsatisfied
6
Other reply (specify)
Other

Excluding holidays away from home, are the following available and how often has ... (child) used them in his/her spare time in the past twelve months? Omit where child does not live at home. Otherwise ring as appropriate. A park, public garden, heath, common or fields where children are allowed to play

1
Not available
2
Never goes though available
3
Goes sometimes
4
Goes often
5
Don't know

Excluding holidays away from home, are the following available and how often has ... (child) used them in his/her spare time in the past twelve months? Omit where child does not live at home. Otherwise ring as appropriate. A recreation ground or outdoor play centre (other than school)

1
Not available
2
Never goes though available
3
Goes sometimes
4
Goes often
5
Don't know

Excluding holidays away from home, are the following available and how often has ... (child) used them in his/her spare time in the past twelve months? Omit where child does not live at home. Otherwise ring as appropriate. Swimming or paddling places which are safe for children

1
Not available
2
Never goes though available
3
Goes sometimes
4
Goes often
5
Don't know

Excluding holidays away from home, are the following available and how often has ... (child) used them in his/her spare time in the past twelve months? Omit where child does not live at home. Otherwise ring as appropriate. An indoor play centre or any children's clubs or societies (e.g. Cubs, Guides, Sports Clubs, Church Clubs for young people)

1
Not available
2
Never goes though available
3
Goes sometimes
4
Goes often
5
Don't know

Excluding holidays away from home, are the following available and how often has ... (child) used them in his/her spare time in the past twelve months? Omit where child does not live at home. Otherwise ring as appropriate. A cinema or other place which has children's film shows.

1
Not available
2
Never goes though available
3
Goes sometimes
4
Goes often
5
Don't know

Excluding holidays away from home, are the following available and how often has ... (child) used them in his/her spare time in the past twelve months? Omit where child does not live at home. Otherwise ring as appropriate. A public library.

1
Not available
2
Never goes though available
3
Goes sometimes
4
Goes often
5
Don't know

Enquire if either parent goes out with the child for walks, outings, picnics, visits. Mother

1
Yes, most weeks
2
Yes, occasionally
3
Never or hardly ever
4
Other reply (please ring and specify)
Other

Enquire if either parent goes out with the child for walks, outings, picnics, visits. Father

1
Yes, most weeks
2
Yes, occasionally
3
Never or hardly ever
4
Other reply (please ring and specify)
Other

Does the mother feel that the father takes a big part in managing the child or leaves it mainly to mother? If father is away a lot ring appropriate code and give details at end of list below.

1
Father takes a big part, or equal part with mother
2
Father takes a smaller part than mother but mother still feels it to be a significant part
3
Father takes a very small part or leaves to mother
4
Don't know
5
Inapplicable (give details)
Generic text

Has either parent belonged to a lending library or book club in the last twelve months? Mother

1
Yes
2
No
3
Other reply (please ring and specify)
Other

Has either parent belonged to a lending library or book club in the last twelve months? Father

1
Yes
2
No
3
Other reply (please ring and specify)
Other

How many times has the family moved home since the child was born. State number of moves, e.g. 6 moves = 6. If 9 or more, enter 9. If the answer is not straight-forward give brief details:

How many
Generic text

What accommodation is occupied by this household?

1
Whole house
2
Flat/maisonette (self-contained)
3
Rooms
4
Caravan
5
Other (please specify)
Other

Is the accommodation:

1
Owned by the household or being bought
2
Rented from Council or New Town Corporation
3
Privately rented-unfurnished
4
Privately rented-furnished
5
Tied to occupation
6
Other reply (please specify)
Other

Is the front door to the accommodation:

1
Below street level
2
At street level/ground floor
3
1st floor
4
2nd floor
5
3rd-4th floor
6
5th-6th floor
7
7th-9th floor
8
10th-12th floor
9
13th floor and above

How many rooms does the accommodation have? Exclude bathroom, scullery or kitchen unless used as a living room. Include rooms used by lodgers or relatives who are members of the household as defined in Question 10 Number of rooms

How many

With how many people does ... (child) share his/her bedroom? Number of people

How many

Does ... (child) share his/her bed with anyone else?

1
Yes
2
No
3
Don't know

Does the accommodation have: (Ask each item) Bathroom

1
Yes-sole use
2
Yes-shared
3
No
4
Don't know

Does the accommodation have: (Ask each item) Outdoor Lavatory

1
Yes-sole use
2
Yes-shared
3
No
4
Don't know

Does the accommodation have: (Ask each item) Indoor Lavatory

1
Yes-sole use
2
Yes-shared
3
No
4
Don't know

Does the accommodation have: (Ask each item) Cooking facilities

1
Yes-sole use
2
Yes-shared
3
No
4
Don't know

Does the accommodation have: (Ask each item) Hot Water Supply

1
Yes-sole use
2
Yes-shared
3
No
4
Don't know

Read this to the parents: 'How satisfied are you with the house (flat, etc.) you live in?'

1
Very satisfied
2
Fairly satisfied
3
No feelings either way
4
Rather dissatisfied
5
Very dissatisfied
6
Don't know
7
Other reply (please specify)
Other

'What is it about your home that makes you feel like that?

Generic text
OCCUPATION OF THE CHILD'S FATHER
OCCUPATION OF THE CHILD'S FATHER
(i.e. present male head of household)
If not working: Write 'Not working' and fill in details of last occupation.
If no male head: Write 'None' but if possible fill in details of employment when he was living in household.
(In completing this question as much detail as possible should be given to indicate the exact type of work done so that we can classify by the skill, qualification or responsibility involved. Terms such as 'electrical worker', 'engineer', civil servant', 'clerk' are insufficient and need explaining.)

Actual job

Generic text

Trade, Industry or Profession

Generic text

Is the father paid weekly, monthly, or is he self-employed?

1
Weekly
2
Monthly
3
Self-employed
4
Don't know
5
Other (specify)
Other
If self-employed:
qc_29_c == 3

How many persons does he employ?

1
None
2
1-24
3
25+
4
Don't know
If not self-employed:
qc_29_c != 3

Does he supervise others? (e.g. foreman, manager, chargehand)

1
Yes
2
No
3
Don't know
If yes, i.e. supervises others:
qc_29_e_i == 1

Approximately how many other persons does he supervise?

1
1-24
2
25+
3
Don't know

Apart from any private source what has been the source of income of the family during the past 12 months? Ring all relevant sources.

1
Employment
2
Sickness benefit/sick pay
3
Unemployment benefit
4
Supplementary benefit (Nat. Assist.)
5
Retirement pension
6
Disability pension
7
Other (specify)
Other

For how many weeks has the father (i.e male head) been off work in the past 12 months through illness or unemployment. Enter number of weeks in boxes. For no weeks put 00. For no male head enter 99. Number of weeks off work through illness,

Weeks in year

For how many weeks has the father (i.e male head) been off work in the past 12 months through illness or unemployment. Enter number of weeks in boxes. For no weeks put 00. For no male head enter 99. Unemployment

Weeks in year

For how many weeks has the father (i.e male head) been off work in the past 12 months through illness or unemployment. Enter number of weeks in boxes. For no weeks put 00. For no male head enter 99. Other (please specify)

Weeks in year
Other

Is the father (i.e male head) engaged in shift work and away from home at night or does he work regular daytime hours?

1
Shift work but not away overnight
2
Shift work and sometimes away overnight
3
Regular night work
4
Works regular daytime hours
5
Other reply (please specify)
Other

Apart from shift work and regular night work does the father's (i.e male head of house) work take him away overnight:

1
At least once a week
2
At least once a month but not every week
3
Sometimes, but less frequently than once a month
4
Never
5
Other reply, e.g. away for long or short periods of time. (Give details
Other

Please enquire own parents' height and weight Father's weight ... stone ... lbs

Stones
Pounds in stone

Please enquire own parents' height and weight Father's height ... feet ... inches

Feet
Inches in foot

Please enquire own parents' height and weight Mother's weight ... stone ... lbs

Stones
Pounds in stone

Please enquire own parents' height and weight Mother's height ... feet ... inches

Feet
Inches in foot

Has the mother had any paid work outside the home since the child was 7?

1
Yes
2
No
3
Don't know
4
Other reply
Other

How many weeks has mother worked full-time and/or part-time in the past 12 months? Please complete both for permanent and temporary jobs. Worked full-time (30 hours or more a week) No. of weeks in Permanent work

Weeks in year

How many weeks has mother worked full-time and/or part-time in the past 12 months? Please complete both for permanent and temporary jobs. Worked full-time (30 hours or more a week) No. of weeks in Temporary work

Weeks in year

How many weeks has mother worked full-time and/or part-time in the past 12 months? Please complete both for permanent and temporary jobs. Worked part-time (under 30 hours) No. of weeks in Permanent work

Weeks in year

How many weeks has mother worked full-time and/or part-time in the past 12 months? Please complete both for permanent and temporary jobs. Worked part-time (under 30 hours) No. of weeks in Temporary work

Weeks in year

Please give full details of most recent job. Exact nature of work

Generic text

Please give full details of most recent job. Supervisory status if any

Generic text

Please give full details of most recent job. Industry/Trade

Generic text

Please give full details of most recent job. Number of days worked per week

Days in week

Please give full details of most recent job. Leaves home

Generic Time

Please give full details of most recent job. Arrives home

Generic Time

Please give full details of most recent job. Date of taking job

Generic date

Please give full details of most recent job. Date of leaving if not working now

Generic date

Does any child of the family receive free school meals at present?

1
Yes
2
No
3
Don't know
4
Other reply (give details)
Other

Ask the parent: 'Have you been seriously troubled by financial hardship in the past 12 months?'

1
Yes
2
No
3
Uncertain
4
Don't know
5
Other reply (give details)
Other
If 'Yes' ask,
qc_37_a == 1

"In what way have you found it difficult to make ends meet?"

Generic text

Enquire or state from your own knowledge if any member of the family has had contact with any social work and/or welfare organisation since the child's 7th birthday. Include Children's, Health, Welfare, Education and Social Service Departments, the Probation Service, and any Voluntary Organisation concerned with children. Exclude Health Visiting and other services normally used by the population as a whole. If Yes, give details

Generic text
Medical History
SIGHT

Does the child have good sight (without glasses)?

1
Yes
2
Sight not good in one eye
3
Sight not good in both eyes
4
Don't know if sight is good
5
No answer

At what age, if any, was poor vision first discovered? (Enter age in years. If sight is good leave blank)

Age
If vision is poor,
qc_39_a == 2 || qc_39_a == 3

please give the reason and diagnosis if known

Generic text

Please ring the appropriate category.

1
Child has never worn glasses
2
Child wears glasses at present
3
Child used to wear glasses in the past but not now
4
Child was prescribed glasses but never wore them
5
Not known if glasses ever worn
6
Has an eye disorder which is not helped by glasses

If applicable enter age at which glasses were first prescribed

Age
For those children who used to wear glasses but no longer do so,
qc_40_a == 3

enter age at which glasses were discarded

Age

Has the child ever had a squint?

1
Yes-squint still present
2
Yes-squint in past only
3
No-never had a squint
4
Don't know whether has had squint

At what age, if any, was squint first noted?

Age
If child has ever had a squint but the squint is now absent,
qc_41_a == 2

enter age when disappeared

Age

What treatment, if any, was he/she given for the squint? (Ring all the codes which apply)

1
Never attended for medical advice
2
Medical advice given-'no treatment needed'
3
Patch over eye
4
Glasses
5
Eye exercises
6
Operation
7
Treatment was advised but not known what
8
Don't know if attended for treatment
HEARING

Has child always had good hearing in both ears?

1
Yes now and always in past
2
Yes now but has been poor in the past
3
No, reduced hearing in one ear only
4
No, reduced hearing in both ears
5
Don't know
If hearing has ever been poor,
qc_42_a == 2 || qc_42_a == 3 || qc_42_a == 4

please give the reason and diagnosis if known

Generic text

At what age, if any, was poor hearing first noted

Age

Has a hearing aid ever been worn?

1
Yes
2
No
3
Don't know
SPEECH

Has the child had any speech difficulty?

1
Yes, has it now
2
Yes, in past only
3
Never
4
Don't know
If appropriate:
qc_44 == 1 || qc_44 == 2

Please specify nature of difficulty

Generic text

Has the child ever had speech therapy?

1
Yes, has it now
2
Yes, in past only
3
No
4
Don't know
BLADDER/BOWEL CONTROL

Is the child completely dry at night?

1
Yes
2
No, wet in past month up to three times
3
No, wet in past month between 4 and 10 times
4
No, wet in past month 11 or more times
5
No, wet at night but don't know how often
6
Don't know if wet at night

Apart from any occasional mishap is the child completely dry by day?

1
Yes
2
No
3
Don't know

Does the child have normal bowel control, i.e does not soil?

1
Yes
2
No
3
Don't know
LATERALITY

Ask mother if the child is:

1
Left-handed
2
Right-handed
3
Mixed right and left
4
Don't know

'Which hand does your child write with?'

1
Left
2
Right
3
Don't know
ACCIDENTS AND INJURIES

Has the child ever received any of the following injuries? Scald/Burn

1
Yes, at home
2
Yes, at school
3
Yes, elsewhere
4
No, never
5
Don't know
If 'Yes'
qc_50_a >= 1 && qc_50_a <= 3

state area affected.

Generic text

Has the child ever received any of the following injuries? Fracture of bone/skull

1
Yes, at home
2
Yes, at school
3
Road accident
4
Yes, elsewhere
5
No, never
6
Don't know
If 'Yes'
qc_50_b >= 1 && qc_50_b <= 4

state area affected.

Generic text

Has the child ever received any of the following injuries? Flesh Wound requiring 10 or more stitches

1
Yes, at home
2
Yes, at school
3
Yes, road accident
4
Yes, elsewhere
5
No, never
6
Don't know
If 'Yes'
qc_50_c >= 1 && qc_50_c <= 4

state area affected.

Generic text

Has the child ever received any of the following injuries? Accident causing unconsciousness

1
Yes, at home
2
Yes, at school
3
Yes, road accident
4
Yes, elsewhere
5
No, never
6
Don't know
If 'Yes'
qc_50_d >= 1 && qc_50_d <= 4

for how long

Generic text

Has the child ever received any of the following injuries? Poison (Swallowed a poisonous or dangerous substance?)

1
Yes
2
No
3
Don't know
If 'Yes'
qc_50_e == 1

please give further details

Generic text

Has the child ever received any of the following injuries? Falls in water (In serious danger of drowning.)

1
Yes
2
No
3
Don't know
If 'Yes'
qc_50_f == 1

please give further details

Generic text
ROAD ACCIDENTS

Has the child ever been involved in a road accident causing injury requiring a stay in hospital overnight or longer?

1
Yes, once
2
Yes, twice
3
Yes, three or more times
4
No, never
5
Don't know
If 'Yes'
qc_51 >= 1 && qc_51 <= 3

please give further details

Generic text
INFECTIOUS DISEASES

Has the child definitely had any of the following illnesses?

1
Measles
2
German Measles
3
Mumps
4
Chicken pox
5
Whooping cough
6
Scarlet fever
7
NONE OF ABOVE

Has the child had any of the following: (enter age)

1
Rheumatic fever
Age

Has the child had any of the following: (enter age)

2
Infectious Hepatitis
Age

Has the child had any of the following: (enter age)

3
Meningitis
Age

Has the child had any of the following: (enter age)

4
Tuberculosis
Age

Has the child had any of the following:

5
NONE OF THE ABOVE
PUBERTAL DEVELOPMENT
If the Study child is a girl,
qc_2 == 2

please ask the question 'Has your daughter had her first menstrual period, and if so at what age?'

1
No, not yet
2
Yes, before 5 years
3
Yes, between 5 and 8 years (inclusive)
4
Yes, aged 9 years
5
Yes, aged 10 years and up to 10 years and 6 months
6
Yes, aged 10 years and 6 months up to 11 years
7
Yes, aged 11 years and over
8
Yes, but don't know when
9
Don't know if child has had first menstrual period
If mother is Study child's own mother,
qc_11_i == 1

please explain that the Study is interested in discovering whether the age at which a mother first menstruates is related to the rate of development of her child(ren). Then ask mother if she would consent to tell us the age at which her own menstrual periods began. Enter age in years. If no information leave blank

Age
MEDICAL CAUSES OF SCHOOL ABSENCE

How much time altogether has the child missed from school (or training centre, etc.) in the past year because of ill health or emotional disturbance? (Please state reason)

1
None, or less than one week in all
2
Over one week and up to one month in all
3
Over one month and up to three months in all
4
Over three months
5
Missed school, but don't know for how long
6
Don't know whether missed school
7
Does not attend school
Generic text
If absent for more than one week in all during the past year,
qc_56 >= 2 && qc_56 <= 4

please indicate reason. If not applicable, leave blank; otherwise ring all relevant codes.

1
Colds, sore throats or ear infections
2
Bronchitis or chest infections
3
Asthma or wheeziness
4
Abdominal pain
5
Headaches
6
Infectious diseases
7
Accident or injury
8
Convulsions, fits or turns
9
Other causes (give details)
Other
ASTHMA or WHEEZY BRONCHITIS

Has the child ever had attacks of:

1
Asthma
2
Wheezy bronchitis
3
Neither of these
4
Don't know
If the child has had asthma or wheezy bronchitis
qc_59 == 1 || qc_59 == 2

what is the frequency of attacks?

1
At least once a week
2
Usually less than once a week but can expect one a month
3
At least one attack in past year but less frequently than one a month
4
Had attacks in past year but don't know how frequently
5
No attacks at all in past year but had attacks when younger
6
Other reply (give details)
Other
CONVULSIONS, TURNS OR FITS

Has the child had any of the following?

1
Major convulsion (or grand mal epilepsy)
2
Minor convulsion (or petit mal epilepsy)
3
Other, or mixed form of epilepsy
4
Fainting or blackouts
5
Other 'attacks' or turns
6
NO ATTACKS AT ALL
7
Don't know
If child has had any attack indicated in Question 61 please enquire:
qc_61 >= 1 && qc_61 <= 5

Age when had most recent attack. Enter age in years at last birthday in boxes, e.g. for 9 yrs. enter 09

Age

Age in years when had first attack. If under 1 year enter 00

Age

Enter details of attacks below: Description

Generic text

Enter details of attacks below: Frequency

Generic text

Enter details of attacks below: Type and duration of treatment

Generic text
MEDICAL TREATMENT

Has the child had any medicaments from a doctor in the last three months (please include also maintenance treatments, e.g. anticonvulsants, insulin, etc.). Enter name of substance, where known opposite category listed Name of substance(s)

1
Liquid medicine
Generic text

Has the child had any medicaments from a doctor in the last three months (please include also maintenance treatments, e.g. anticonvulsants, insulin, etc.). Enter name of substance, where known opposite category listed Name of substance(s)

2
Tablets or pills
Generic text

Has the child had any medicaments from a doctor in the last three months (please include also maintenance treatments, e.g. anticonvulsants, insulin, etc.). Enter name of substance, where known opposite category listed Name of substance(s)

3
Inhalers
Generic text

Has the child had any medicaments from a doctor in the last three months (please include also maintenance treatments, e.g. anticonvulsants, insulin, etc.). Enter name of substance, where known opposite category listed Name of substance(s)

4
Injections
Generic text

Has the child had any medicaments from a doctor in the last three months (please include also maintenance treatments, e.g. anticonvulsants, insulin, etc.). Enter name of substance, where known opposite category listed Name of substance(s)

5
Other treatment
Generic text

Has the child had any medicaments from a doctor in the last three months (please include also maintenance treatments, e.g. anticonvulsants, insulin, etc.). Enter name of substance, where known opposite category listed

6
NOT HAD ANY TREATMENT
7
Don't know
If child has had of the above in the last three months,
qc_63_a_i == 1 || qc_63_a_ii == 2 || qc_63_a_iii == 3 || qc_63_a_iv == 4 || qc_63_a_v == 5

for what reason was (were) the medicament(s) given? Ring all appropriate codes.

1
Convulsions or turns
2
Wheeziness or asthma
3
Diabetes
4
Other reason (specify)
Other
GENERAL HEALTH

Has the child suffered in the past twelve months from any of the following? Recurrent headaches or migraine

1
Yes
2
No
3
Don't know

Has the child suffered in the past twelve months from any of the following? Hay fever or allergic rhintis

1
Yes
2
No
3
Don't know

Has the child suffered in the past twelve months from any of the following? Recurrent vomiting or bilious attacks

1
Yes
2
No
3
Don't know

Has the child suffered in the past twelve months from any of the following? Recurrent abdominal pains

1
Yes
2
No
3
Don't know

Has the child suffered in the past twelve months from any of the following? Travel sickness

1
Yes
2
No
3
Don't know

Has the child suffered in the past twelve months from any of the following? Tics or habit spasms

1
Yes
2
No
3
Don't know

Has the child suffered in the past twelve months from any of the following? Recurrent mouth ulcers

1
Yes
2
No
3
Don't know

Has the child suffered in the past twelve months from any of the following? Recurrent throat and/or ear infections requiring treatment by a doctor

1
Yes
2
No
3
Don't know

Has the child suffered in the past twelve months from any of the following? Discharging ears (pus, not wax)

1
Yes
2
No
3
Don't know

Has the child suffered in the past twelve months from any of the following? Eczematous rashes

1
Yes
2
No
3
Don't know

Has the child suffered in the past twelve months from any of the following? Psoriasis

1
Yes
2
No
3
Don't know

Has the child suffered in the past twelve months from any of the following? Any heart complaint

1
Yes
2
No
3
Don't know
If yes,
qc_64_l == 1

what have the parents been told about their child's heart?

Generic text

Has the child had any of the following operations: Removal of tonsils with or without adenoids

1
Yes
2
No
3
Don't know

Has the child had any of the following operations: Removal of tonsils with or without adenoids At what age?

Age

Has the child had any of the following operations: Removal of adenoids alone

1
Yes
2
No
3
Don't know

Has the child had any of the following operations: Removal of adenoids alone At what age?

Age

Has the child had any of the following operations: Circumcision (for girls leave blank)

1
Yes
2
No
3
Don't know

Has the child had any of the following operations: Circumcision (for girls leave blank) At what age?

Age

Has the child had any of the following operations: Repair of hernia

1
Yes
2
No
3
Don't know

Has the child had any of the following operations: Repair of hernia At what age?

Age

Has the child had any of the following operations: Removal of appendix

1
Yes
2
No
3
Don't know

Has the child had any of the following operations: Removal of appendix At what age?

Age

Has the child had a dental inspection in the past year?

1
Yes
2
No
3
Don't know

Were any of the following required? (Please indicate person responsible for treatment by ringing as appropriate) Filling

1
No
2
School Dentist
3
N.H.S. Family Dentist
4
Dentist in Hospital
5
Private (Fee paid) Dentist
6
Don't know

Were any of the following required? (Please indicate person responsible for treatment by ringing as appropriate) Extraction of teeth

1
No
2
School Dentist
3
N.H.S. Family Dentist
4
Dentist in Hospital
5
Private (Fee paid) Dentist
6
Don't know

Were any of the following required? (Please indicate person responsible for treatment by ringing as appropriate) Treatment to straighten teeth

1
No
2
School Dentist
3
N.H.S. Family Dentist
4
Dentist in Hospital
5
Private (Fee paid) Dentist
6
Don't know

Were any of the following required? (Please indicate person responsible for treatment by ringing as appropriate) Any false teeth made or crowning of teeth

1
No
2
School Dentist
3
N.H.S. Family Dentist
4
Dentist in Hospital
5
Private (Fee paid) Dentist
6
Don't know

Has the child ever been seen by or had specialist treatment from a medical/surgical specialist for any of the following? (Do not include treatment from a General Practitioner or Hospital Casualty Department). Eye disorder/vision/squint

1
Never
2
OUTPATIENT AT Hospital/clinic/at home/consulting rooms
3
INPATIENT Hospital/nursing home
4
Don't know

Has the child ever been seen by or had specialist treatment from a medical/surgical specialist for any of the following? (Do not include treatment from a General Practitioner or Hospital Casualty Department). Actual or suspected hearing loss

1
Never
2
OUTPATIENT AT Hospital/clinic/at home/consulting rooms
3
INPATIENT Hospital/nursing home
4
Don't know

Has the child ever been seen by or had specialist treatment from a medical/surgical specialist for any of the following? (Do not include treatment from a General Practitioner or Hospital Casualty Department). Nose, palate, ears (exclude hearing)

1
Never
2
OUTPATIENT AT Hospital/clinic/at home/consulting rooms
3
INPATIENT Hospital/nursing home
4
Don't know

Has the child ever been seen by or had specialist treatment from a medical/surgical specialist for any of the following? (Do not include treatment from a General Practitioner or Hospital Casualty Department). Asthma or wheezy bronchitis

1
Never
2
OUTPATIENT AT Hospital/clinic/at home/consulting rooms
3
INPATIENT Hospital/nursing home
4
Don't know

Has the child ever been seen by or had specialist treatment from a medical/surgical specialist for any of the following? (Do not include treatment from a General Practitioner or Hospital Casualty Department). Convulsions or fits

1
Never
2
OUTPATIENT AT Hospital/clinic/at home/consulting rooms
3
INPATIENT Hospital/nursing home
4
Don't know

Has the child ever been seen by or had specialist treatment from a medical/surgical specialist for any of the following? (Do not include treatment from a General Practitioner or Hospital Casualty Department). Enuresis

1
Never
2
OUTPATIENT AT Hospital/clinic/at home/consulting rooms
3
INPATIENT Hospital/nursing home
4
Don't know

Has the child ever been seen by or had specialist treatment from a medical/surgical specialist for any of the following? (Do not include treatment from a General Practitioner or Hospital Casualty Department). Disturbed behaviour, including emotional problems

1
Never
2
OUTPATIENT AT Hospital/clinic/at home/consulting rooms
3
INPATIENT Hospital/nursing home
4
Don't know

Has the child ever been seen by or had specialist treatment from a medical/surgical specialist for any of the following? (Do not include treatment from a General Practitioner or Hospital Casualty Department). Any operation (include any previously mentioned)

1
Never
2
OUTPATIENT AT Hospital/clinic/at home/consulting rooms
3
INPATIENT Hospital/nursing home
4
Don't know

We wish to know about all uses of hospital services by children, so please ask: Has the child ever been admitted to hospital overnight or longer including any occasions already mentioned?

1
Yes, before 7 years old only
2
Yes, after 7 years old only
3
Yes, both before and after 7 years of age
4
Never
5
Don't know
*
Other (please specify)
Other
If yes,
qc_68_a >= 1 && qc_68_a <= 3

how many times has the child been admitted to hospital? Please enter the total number of times in the boxes. If none, enter 00, for three times 03 etc.

How many
Please give details of these admissions.
Details including diagnosis or reason for admission or operation Age when admitted Name and address of hospital or nursing home
Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text
FIRST ADMISSION
SECOND ADMISSION
THIRD ADMISSION
FOURTH ADMISSION
FIFTH ADMISSION

If more than five times enter below:

Generic text
Now enter similar details concerning complaints which have received specialist treatment at OUTPATIENT hospital/clinic/domiciliary or private consulting rooms. (Only record first visits for each complaint, not follow-up visits).
Details including diagnosis or reason why seen by specialist Age when seen Name and address of hospital or private specialist
Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text
1
2
3
4
5

Name and address of child's General Practitioner:

Generic text

Since the child's 7th birthday has either parent (or parent substitute) suffered from chronic or serious disability or ill-health, including any hospital in-patient admission of two weeks or longer?

1
Yes, mother only
2
Yes, father only
3
Yes, both parents
4
No, neither parent
5
Don't know
6
Other answer (please specify)
Other
If yes
qc_71_a >= 1 && qc_71_a <= 3

What is/was the condition? Mother

Generic text

What is/was the condition? Father

Generic text

How long was parent in hospital? Mother

Generic text

How long was parent in hospital? Father

Generic text

In what year was condition first apparent? Mother

Generic date

In what year was condition first apparent? Father

Generic date

What is the present state of health? Mother

Generic text

What is the present state of health? Father

Generic text

Since the child's 7th birthday, has any other adult in the household suffered from chronic or serious disability or ill-health, including any hospital in-patient admission of two weeks or longer?

1
Yes
2
No
3
Don't know
4
Other (please specify)
Other
If Yes
qc_72_a == 1

What is/was the relationship of the person concerned to the study child

Generic text

What was/is the condition

Generic text

In what year was the condition first apparent

Generic date

What is his/her present state of health?

Generic text

Since the Study child's seventh birthday has any other child of the household suffered from chronic or serious disability or ill-health including any hospital in-patient admission of 2 weeks or longer and attendance at a special school.

1
Yes
2
No
3
Don't know
4
Other (please specify)
Other
If Yes
qc_73_a == 1

What is the relationship of the child(ren) concerned to the Study child?

Generic text

What is/was the condition?

Generic text

In what year was the condition first apparent?

Generic date

What is his/her present state of health?

Generic text

Please enquire where the parents were born. Place of birth (town, county and country) Mother

Generic text

Please enquire where the parents were born. Place of birth (town, county and country) Father

Generic text
If not born in Great Britain,

in which year did parents come to live in this country? Year of arrival Mother

Generic date

in which year did parents come to live in this country? Year of arrival Father

Generic date

Is English the usual language spoken in the child's home?

1
Yes
2
No
3
Other reply (give details)
Other

Read this to the mother: 'I want to ask you in a minute about some descriptions of behaviour often shown by children, but first would you tell me what it is about ... (child) that pleases you most?

Generic text

Please read this to mother: 'I am going to mention three difficulties which children have sometimes. I'd like you to tell me if any of these have occurred in the last three months.' Has occurred in last 3 months Has been reluctant to go to school

1
Yes
2
No
3
Don't know
9
Inapplicable

Please read this to mother: 'I am going to mention three difficulties which children have sometimes. I'd like you to tell me if any of these have occurred in the last three months.' Has occurred in last 3 months Has had bad dreams or night terrors

1
Yes
2
No
3
Don't know
9
Inapplicable

Please read this to mother: 'I am going to mention three difficulties which children have sometimes. I'd like you to tell me if any of these have occurred in the last three months.' Has occurred in last 3 months Has sleepwalked

1
Yes
2
No
3
Don't know
9
Inapplicable

Read this to the mother: 'Now I am going to mention some descriptions of behaviour shown by children. Could you tell me first whether these kinds of behaviour never happen with ... (child), or whether they happen sometimes or frequently at the present time.' Has difficulty in settling to anything for more than a few moments

1
Never
2
Sometimes
3
Frequently
4
Don't know
9
Inapplicable

Read this to the mother: 'Now I am going to mention some descriptions of behaviour shown by children. Could you tell me first whether these kinds of behaviour never happen with ... (child), or whether they happen sometimes or frequently at the present time.' Prefers to do things on his/her own rather than with others

1
Never
2
Sometimes
3
Frequently
4
Don't know
9
Inapplicable

Read this to the mother: 'Now I am going to mention some descriptions of behaviour shown by children. Could you tell me first whether these kinds of behaviour never happen with ... (child), or whether they happen sometimes or frequently at the present time.' Is bullied by other children

1
Never
2
Sometimes
3
Frequently
4
Don't know
9
Inapplicable

Read this to the mother: 'Now I am going to mention some descriptions of behaviour shown by children. Could you tell me first whether these kinds of behaviour never happen with ... (child), or whether they happen sometimes or frequently at the present time.' Destroys own or other's belongings (e.g. tears or breaks)

1
Never
2
Sometimes
3
Frequently
4
Don't know
9
Inapplicable

Read this to the mother: 'Now I am going to mention some descriptions of behaviour shown by children. Could you tell me first whether these kinds of behaviour never happen with ... (child), or whether they happen sometimes or frequently at the present time.' Is miserable or tearful

1
Never
2
Sometimes
3
Frequently
4
Don't know
9
Inapplicable

Read this to the mother: 'Now I am going to mention some descriptions of behaviour shown by children. Could you tell me first whether these kinds of behaviour never happen with ... (child), or whether they happen sometimes or frequently at the present time.' Is squirmy or fidgety

1
Never
2
Sometimes
3
Frequently
4
Don't know
9
Inapplicable

Read this to the mother: 'Now I am going to mention some descriptions of behaviour shown by children. Could you tell me first whether these kinds of behaviour never happen with ... (child), or whether they happen sometimes or frequently at the present time.' Worries about many things

1
Never
2
Sometimes
3
Frequently
4
Don't know
9
Inapplicable

Read this to the mother: 'Now I am going to mention some descriptions of behaviour shown by children. Could you tell me first whether these kinds of behaviour never happen with ... (child), or whether they happen sometimes or frequently at the present time.' Is irritable, quick to fly off the handle

1
Never
2
Sometimes
3
Frequently
4
Don't know
9
Inapplicable

Read this to the mother: 'Now I am going to mention some descriptions of behaviour shown by children. Could you tell me first whether these kinds of behaviour never happen with ... (child), or whether they happen sometimes or frequently at the present time.' Sucks thumb or finger during the day

1
Never
2
Sometimes
3
Frequently
4
Don't know
9
Inapplicable

Read this to the mother: 'Now I am going to mention some descriptions of behaviour shown by children. Could you tell me first whether these kinds of behaviour never happen with ... (child), or whether they happen sometimes or frequently at the present time.' Is upset by new situation, by things happening for first time

1
Never
2
Sometimes
3
Frequently
4
Don't know
9
Inapplicable

Read this to the mother: 'Now I am going to mention some descriptions of behaviour shown by children. Could you tell me first whether these kinds of behaviour never happen with ... (child), or whether they happen sometimes or frequently at the present time.' Has twitches or mannerisms of the face, eyes or body

1
Never
2
Sometimes
3
Frequently
4
Don't know
9
Inapplicable

Read this to the mother: 'Now I am going to mention some descriptions of behaviour shown by children. Could you tell me first whether these kinds of behaviour never happen with ... (child), or whether they happen sometimes or frequently at the present time.' Fights with other children

1
Never
2
Sometimes
3
Frequently
4
Don't know
9
Inapplicable

Read this to the mother: 'Now I am going to mention some descriptions of behaviour shown by children. Could you tell me first whether these kinds of behaviour never happen with ... (child), or whether they happen sometimes or frequently at the present time.' Bites nails

1
Never
2
Sometimes
3
Frequently
4
Don't know
9
Inapplicable

Read this to the mother: 'Now I am going to mention some descriptions of behaviour shown by children. Could you tell me first whether these kinds of behaviour never happen with ... (child), or whether they happen sometimes or frequently at the present time.' Is disobedient at home

1
Never
2
Sometimes
3
Frequently
4
Don't know
9
Inapplicable

Finally, please ask for the child's National Health Service Number

Generic text

INTERVIEWER'S COMMENTS. Please add any other relevant information which you feel has not already been brought out by the interview form.

Long text
END OF INTERVIEW
Please thank the mother very much on our behalf for her help
End

ncds_69_pq

STRICTLY CONFIDENTIAL
PARENTAL INTERVIEW FORM
NATIONAL CHILD DEVELOPMENT STUDY
(1958 Cohort)
SPONSORED AND ADMINISTERED BY: National Bureau for Co-operation in Child Care
CO-SPONSORED BY: Institute of Child Health, University of London National Birthday Trust Fund National Foundation for Educational Research in England and Wales
IN COLLABORATION WITH: ENGLAND AND WALES Association of Chief Education Officers Society of Medical Officers of Health SCOTLAND Association of Directors of Education Association of School Medical and Dental Officers
CHAIRMAN OF CONSULTATIVE COMMITTEE: Mary D. Sheridan, O.B.E., M.A., M.D., D.C.H.
CHAIRMAN OF STEERING COMMITTEE: W.D. Wall, B.A., PH.D.
EXECUTIVE CO-DIRECTORS: Professor N. R. Butler, M.D., F.R.C.P., D.C.H. Mrs M. L. Kellmer Pringle B.A., PH.D., DIP.ED.PSYCH.
CO-DIRECTOR AND PRINCIPAL INVESTIGATOR: R. Davie, B.A., DIP.ED.PSYCH.
CO-DIRECTORS: M. J. R. Healy, B.A. J. M. Tanner, M.D., D.SC., M.R.C.P. W. D. Wall, B.A., PH.D.
SENIOR RESEARCH OFFICER: P. J. Wedge, M.A., DIP.PUB.SOC.ADMIN., DIP.APP.SOC.STUD.
SECOND FOLLOW-UP OF CHILDREN
CHILD'S NAME (Surname)
Generic text
CHILD'S NAME (Christian names)
Generic text
CHILD'S SEX (Please ring appropriate number)
1
Boy
2
Girl
TODAY'S DATE
Generic date
DATE OF CHILD'S BIRTH
Date of birth
CHILD'S PRESENT HOME ADDRESS
Generic text
CHILD'S HOME ADDRESS AT TIME OF BIRTH
Generic text
PLACE OF BIRTH IF DIFFERENT FROM ABOVE
Generic text
CHILD'S HOME ADDRESS AT THE TIME OF FIRST FOLLOW-UP (AGED SEVEN)
Generic text
please give approximate date child came to live in this country
Generic date
NAME OF INTERVIEWER
Generic text
NAME OF INFORMANT (Surname)
Generic text
NAME OF INFORMANT (Christian names)
Generic text
RELATIONSHIP OF INFORMANT TO THE STUDY CHILD
1
Mother (or Mother Substitute)
2
Other (please specify)
Other
* PLEASE READ THE INTRODUCTORY NOTES OVERLEAF ON PAGE 2

PEOPLE IN THE HOUSEHOLD

A household comprises the group of persons living together partaking of meals prepared together and benefiting from a common housekeeping.

Who normally lives in the Study child's household? Exclude any children or others who are only at home for short periods, for example, school holidays.

Relationship to Study Child (e.g. Father, Stepbrother) or Status in Household (e.g. Lodger). Roster cs_q10_a_X Generic text Age Generic text Generic text Age Generic text Age Generic text Generic text
Study Child 1 Surname
Study Child 1 Christian Name
Study Child 1 Age (in years)
Study Child 2 Surname
Study Child 2 Christian Name
Study Child 2 Age (in years)
Study Child 3 Surname
Study Child 3 Christian Name
Study Child 3 Age (in years)
Study Child 4 Surname
Study Child 4 Christian Name
Study Child 4 Age (in years)
Study Child 5 Surname
Study Child 5 Christian Name
Study Child 5 Age (in years)
Study Child 6 Surname
Study Child 6 Christian Name
Study Child 6 Age (in years)
Study Child 7 Surname
Study Child 7 Christian Name
Study Child 7 Age (in years)
Study Child 8 Surname
Study Child 8 Christian Name
Study Child 8 Age (in years)

List below, any member of the family (under the age of 21 years) not included in the above table, for example those who are only home for holidays or leave, and enquire or state from your own knowledge the reason for absence, for example, at residential special school, or working away.

Relationship to Study Child Surname Christian Name Age (in years) Reason for Absence from Home
Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text
1
2
3
4

Enter the following details of any children born to the Study child's OWN MOTHER subsequent to the Study child. Include both members of twin pairs separately and omit miscarriages.

NAME Roster cs_q10_c_X Ounces in pound cs_q10_c_i Date of birth cs_q10_c_ii Pounds Ounces in pound Pounds cs_q10_c_ii Date of birth cs_q10_c_i Pounds cs_q10_c_i cs_q10_c_ii Ounces in pound Date of birth Date of birth cs_q10_c_i Ounces in pound Pounds cs_q10_c_ii Pounds Ounces in pound cs_q10_c_i Date of birth cs_q10_c_ii

1 - Male

2 - Female

3 - Alive now

4 - Stillbirth

5 - Died subsequently

3 - Alive now

4 - Stillbirth

5 - Died subsequently

1 - Male

2 - Female

1 - Male

2 - Female

3 - Alive now

4 - Stillbirth

5 - Died subsequently

1 - Male

2 - Female

3 - Alive now

4 - Stillbirth

5 - Died subsequently

1 - Male

2 - Female

3 - Alive now

4 - Stillbirth

5 - Died subsequently

Study Child 1 DATE OF BIRTH
Study Child 1 SEX
Study Child 1 SURVIVAL
Study Child 1 BIRTH WEIGHT (Approx. if necessary lbs
Study Child 1 BIRTH WEIGHT (Approx. if necessary ozs
Study Child 2 DATE OF BIRTH
Study Child 2 SEX
Study Child 2 SURVIVAL
Study Child 2 BIRTH WEIGHT (Approx. if necessary lbs
Study Child 2 BIRTH WEIGHT (Approx. if necessary ozs
Study Child 3 DATE OF BIRTH
Study Child 3 SEX
Study Child 3 SURVIVAL
Study Child 3 BIRTH WEIGHT (Approx. if necessary lbs
Study Child 3 BIRTH WEIGHT (Approx. if necessary ozs
Study Child 4 DATE OF BIRTH
Study Child 4 SEX
Study Child 4 SURVIVAL
Study Child 4 BIRTH WEIGHT (Approx. if necessary lbs
Study Child 4 BIRTH WEIGHT (Approx. if necessary ozs
Study Child 5 DATE OF BIRTH
Study Child 5 SEX
Study Child 5 SURVIVAL
Study Child 5 BIRTH WEIGHT (Approx. if necessary lbs
Study Child 5 BIRTH WEIGHT (Approx. if necessary ozs
Study Child 6 DATE OF BIRTH
Study Child 6 SEX
Study Child 6 SURVIVAL
Study Child 6 BIRTH WEIGHT (Approx. if necessary lbs
Study Child 6 BIRTH WEIGHT (Approx. if necessary ozs
Study Child 7 DATE OF BIRTH
Study Child 7 SEX
Study Child 7 SURVIVAL
Study Child 7 BIRTH WEIGHT (Approx. if necessary lbs
Study Child 7 BIRTH WEIGHT (Approx. if necessary ozs
Please enter the following information in respect of any deceased child of the Study child's own mother. Include children born before and after the Study child. the age at death ... years ... months
Age
Months
Please enter the following information in respect of any deceased child of the Study child's own mother. Include children born before and after the Study child. the cause of death
Generic text
Was the Study child's birth single or multiple?
1
Single
2
Multiple
3
Don't know
The actual relationship to the Study child of the persons acting as the child's parents is: (Please ring as appropriate) MOTHER
1
Own (or natural) mother
2
Mother by legal adoption
3
Step-mother
4
Foster-mother
5
Grandmother
6
Elder sister
7
No mother figure
8
Other (please specify)
Other
why child is not living with his/her own or adoptive mother.
Generic text
at what age child came under the care of present mother-substitute. State age in box, e.g. 6 yrs = 06 10 yrs = 10
Age
The actual relationship to the Study child of the persons acting as the child's parents is: (Please ring as appropriate) FATHER
1
Own (or natural) father
2
Father by legal adoption
3
Step-father
4
Foster-father
5
Grandfather
6
Elder brother
7
No father figure
8
Other (please specify)
Other
why child is not living with his/her own or adoptive father.
Generic text
at what age child came under the care of present father-substitute. State age in box, e.g. 6 yrs = 06 10 yrs = 10
Age
Has the child been looked after for more than one month by any mother-figure other than the one indicated in Question 11. (Exclude hospital admissions and boarding school attendance.)
1
Yes
2
No
3
Don't know
Has this child ever been in the care of a Local Authority Children's Committee?
1
Yes, in care now
2
Yes, in care only in the past
3
No, has never been in care
4
Don't know
5
Other reply (give details)
Other
what was child's age at the time of admission to care (or at the last time of admission if more than one) and the name of the Local Authority. Age
Age
what was child's age at the time of admission to care (or at the last time of admission if more than one) and the name of the Local Authority. Name of Local Authority
Generic text
Has the child ever been in the care of a Voluntary Society?
1
Yes, in care now
2
Yes, in care only in the past
3
No, has never been in care
4
Don't know
5
Other reply (give details)
Other
what was the child's age at the time of admission to care (at the last time of admission if more than one) and the name of the Voluntary Society. Age
Age
what was the child's age at the time of admission to care (at the last time of admission if more than one) and the name of the Voluntary Society. Name of Voluntary Society
Generic text
How many schools has the child attended since the age of 5 years, not counting moves from one department to another of the same school. Write the actual number in the box, and if 9 or more enter 9. If answer is not straightforward, give details
How many
Generic text
Read this to the parent: 'Would you like ... (child's name) to leave school as soon as possible or stay on longer?'
1
Leave as soon as possible
2
Stay on longer
3
Don't know yet
Read this to the parent: 'Do you hope that after leaving school ... (child's name) will undertake further training or education (full-time or part-time)?'
1
Yes
2
No
3
Don't know yet
Read this to the mother: 'How satisfied are you with play amenities for ... (child's name) within about 10-15 minutes walk of here?'
1
Very satisfied
2
Fairly satisfied
3
No feelings either way
4
Rather unsatisfied
5
Very unsatisfied
6
Other reply (specify)
Other
Excluding holidays away from home, are the following available and how often has ... (child) used them in his/her spare time in the past twelve months? Omit where child does not live at home. Otherwise ring as appropriate. A park, public garden, heath, common or fields where children are allowed to play
1
Not available
2
Never goes though available
3
Goes sometimes
4
Goes often
5
Don't know
Excluding holidays away from home, are the following available and how often has ... (child) used them in his/her spare time in the past twelve months? Omit where child does not live at home. Otherwise ring as appropriate. A recreation ground or outdoor play centre (other than school)
1
Not available
2
Never goes though available
3
Goes sometimes
4
Goes often
5
Don't know
Excluding holidays away from home, are the following available and how often has ... (child) used them in his/her spare time in the past twelve months? Omit where child does not live at home. Otherwise ring as appropriate. Swimming or paddling places which are safe for children
1
Not available
2
Never goes though available
3
Goes sometimes
4
Goes often
5
Don't know
Excluding holidays away from home, are the following available and how often has ... (child) used them in his/her spare time in the past twelve months? Omit where child does not live at home. Otherwise ring as appropriate. An indoor play centre or any children's clubs or societies (e.g. Cubs, Guides, Sports Clubs, Church Clubs for young people)
1
Not available
2
Never goes though available
3
Goes sometimes
4
Goes often
5
Don't know
Excluding holidays away from home, are the following available and how often has ... (child) used them in his/her spare time in the past twelve months? Omit where child does not live at home. Otherwise ring as appropriate. A cinema or other place which has children's film shows.
1
Not available
2
Never goes though available
3
Goes sometimes
4
Goes often
5
Don't know
Excluding holidays away from home, are the following available and how often has ... (child) used them in his/her spare time in the past twelve months? Omit where child does not live at home. Otherwise ring as appropriate. A public library.
1
Not available
2
Never goes though available
3
Goes sometimes
4
Goes often
5
Don't know
Enquire if either parent goes out with the child for walks, outings, picnics, visits. Mother
1
Yes, most weeks
2
Yes, occasionally
3
Never or hardly ever
4
Other reply (please ring and specify)
Other
Enquire if either parent goes out with the child for walks, outings, picnics, visits. Father
1
Yes, most weeks
2
Yes, occasionally
3
Never or hardly ever
4
Other reply (please ring and specify)
Other
Does the mother feel that the father takes a big part in managing the child or leaves it mainly to mother? If father is away a lot ring appropriate code and give details at end of list below.
1
Father takes a big part, or equal part with mother
2
Father takes a smaller part than mother but mother still feels it to be a significant part
3
Father takes a very small part or leaves to mother
4
Don't know
5
Inapplicable (give details)
Generic text
Has either parent belonged to a lending library or book club in the last twelve months? Mother
1
Yes
2
No
3
Other reply (please ring and specify)
Other
Has either parent belonged to a lending library or book club in the last twelve months? Father
1
Yes
2
No
3
Other reply (please ring and specify)
Other
How many times has the family moved home since the child was born. State number of moves, e.g. 6 moves = 6. If 9 or more, enter 9. If the answer is not straight-forward give brief details:
How many
Generic text
What accommodation is occupied by this household?
1
Whole house
2
Flat/maisonette (self-contained)
3
Rooms
4
Caravan
5
Other (please specify)
Other
Is the accommodation:
1
Owned by the household or being bought
2
Rented from Council or New Town Corporation
3
Privately rented-unfurnished
4
Privately rented-furnished
5
Tied to occupation
6
Other reply (please specify)
Other
Is the front door to the accommodation:
1
Below street level
2
At street level/ground floor
3
1st floor
4
2nd floor
5
3rd-4th floor
6
5th-6th floor
7
7th-9th floor
8
10th-12th floor
9
13th floor and above
How many rooms does the accommodation have? Exclude bathroom, scullery or kitchen unless used as a living room. Include rooms used by lodgers or relatives who are members of the household as defined in Question 10 Number of rooms
How many
With how many people does ... (child) share his/her bedroom? Number of people
How many
Does ... (child) share his/her bed with anyone else?
1
Yes
2
No
3
Don't know
Does the accommodation have: (Ask each item) Bathroom
1
Yes-sole use
2
Yes-shared
3
No
4
Don't know
Does the accommodation have: (Ask each item) Outdoor Lavatory
1
Yes-sole use
2
Yes-shared
3
No
4
Don't know
Does the accommodation have: (Ask each item) Indoor Lavatory
1
Yes-sole use
2
Yes-shared
3
No
4
Don't know
Does the accommodation have: (Ask each item) Cooking facilities
1
Yes-sole use
2
Yes-shared
3
No
4
Don't know
Does the accommodation have: (Ask each item) Hot Water Supply
1
Yes-sole use
2
Yes-shared
3
No
4
Don't know
Read this to the parents: 'How satisfied are you with the house (flat, etc.) you live in?'
1
Very satisfied
2
Fairly satisfied
3
No feelings either way
4
Rather dissatisfied
5
Very dissatisfied
6
Don't know
7
Other reply (please specify)
Other
'What is it about your home that makes you feel like that?
Generic text

OCCUPATION OF THE CHILD'S FATHER

OCCUPATION OF THE CHILD'S FATHER
(i.e. present male head of household)
If not working: Write 'Not working' and fill in details of last occupation.
If no male head: Write 'None' but if possible fill in details of employment when he was living in household.
(In completing this question as much detail as possible should be given to indicate the exact type of work done so that we can classify by the skill, qualification or responsibility involved. Terms such as 'electrical worker', 'engineer', civil servant', 'clerk' are insufficient and need explaining.)
Actual job
Generic text
Trade, Industry or Profession
Generic text
Is the father paid weekly, monthly, or is he self-employed?
1
Weekly
2
Monthly
3
Self-employed
4
Don't know
5
Other (specify)
Other
How many persons does he employ?
1
None
2
1-24
3
25+
4
Don't know
Does he supervise others? (e.g. foreman, manager, chargehand)
1
Yes
2
No
3
Don't know
Approximately how many other persons does he supervise?
1
1-24
2
25+
3
Don't know
Apart from any private source what has been the source of income of the family during the past 12 months? Ring all relevant sources.
1
Employment
2
Sickness benefit/sick pay
3
Unemployment benefit
4
Supplementary benefit (Nat. Assist.)
5
Retirement pension
6
Disability pension
7
Other (specify)
Other
For how many weeks has the father (i.e male head) been off work in the past 12 months through illness or unemployment. Enter number of weeks in boxes. For no weeks put 00. For no male head enter 99. Number of weeks off work through illness,
Weeks in year
For how many weeks has the father (i.e male head) been off work in the past 12 months through illness or unemployment. Enter number of weeks in boxes. For no weeks put 00. For no male head enter 99. Unemployment
Weeks in year
For how many weeks has the father (i.e male head) been off work in the past 12 months through illness or unemployment. Enter number of weeks in boxes. For no weeks put 00. For no male head enter 99. Other (please specify)
Weeks in year
Other
Is the father (i.e male head) engaged in shift work and away from home at night or does he work regular daytime hours?
1
Shift work but not away overnight
2
Shift work and sometimes away overnight
3
Regular night work
4
Works regular daytime hours
5
Other reply (please specify)
Other
Apart from shift work and regular night work does the father's (i.e male head of house) work take him away overnight:
1
At least once a week
2
At least once a month but not every week
3
Sometimes, but less frequently than once a month
4
Never
5
Other reply, e.g. away for long or short periods of time. (Give details
Other
Please enquire own parents' height and weight Father's weight ... stone ... lbs
Stones
Pounds in stone
Please enquire own parents' height and weight Father's height ... feet ... inches
Feet
Inches in foot
Please enquire own parents' height and weight Mother's weight ... stone ... lbs
Stones
Pounds in stone
Please enquire own parents' height and weight Mother's height ... feet ... inches
Feet
Inches in foot
Has the mother had any paid work outside the home since the child was 7?
1
Yes
2
No
3
Don't know
4
Other reply
Other
How many weeks has mother worked full-time and/or part-time in the past 12 months? Please complete both for permanent and temporary jobs. Worked full-time (30 hours or more a week) No. of weeks in Permanent work
Weeks in year
How many weeks has mother worked full-time and/or part-time in the past 12 months? Please complete both for permanent and temporary jobs. Worked full-time (30 hours or more a week) No. of weeks in Temporary work
Weeks in year
How many weeks has mother worked full-time and/or part-time in the past 12 months? Please complete both for permanent and temporary jobs. Worked part-time (under 30 hours) No. of weeks in Permanent work
Weeks in year
How many weeks has mother worked full-time and/or part-time in the past 12 months? Please complete both for permanent and temporary jobs. Worked part-time (under 30 hours) No. of weeks in Temporary work
Weeks in year
Please give full details of most recent job. Exact nature of work
Generic text
Please give full details of most recent job. Supervisory status if any
Generic text
Please give full details of most recent job. Industry/Trade
Generic text
Please give full details of most recent job. Number of days worked per week
Days in week
Please give full details of most recent job. Leaves home
Generic Time
Please give full details of most recent job. Arrives home
Generic Time
Please give full details of most recent job. Date of taking job
Generic date
Please give full details of most recent job. Date of leaving if not working now
Generic date
Does any child of the family receive free school meals at present?
1
Yes
2
No
3
Don't know
4
Other reply (give details)
Other
Ask the parent: 'Have you been seriously troubled by financial hardship in the past 12 months?'
1
Yes
2
No
3
Uncertain
4
Don't know
5
Other reply (give details)
Other
"In what way have you found it difficult to make ends meet?"
Generic text
Enquire or state from your own knowledge if any member of the family has had contact with any social work and/or welfare organisation since the child's 7th birthday. Include Children's, Health, Welfare, Education and Social Service Departments, the Probation Service, and any Voluntary Organisation concerned with children. Exclude Health Visiting and other services normally used by the population as a whole. If Yes, give details
Generic text

Medical History

SIGHT

Does the child have good sight (without glasses)?
1
Yes
2
Sight not good in one eye
3
Sight not good in both eyes
4
Don't know if sight is good
5
No answer
At what age, if any, was poor vision first discovered? (Enter age in years. If sight is good leave blank)
Age
please give the reason and diagnosis if known
Generic text
Please ring the appropriate category.
1
Child has never worn glasses
2
Child wears glasses at present
3
Child used to wear glasses in the past but not now
4
Child was prescribed glasses but never wore them
5
Not known if glasses ever worn
6
Has an eye disorder which is not helped by glasses
If applicable enter age at which glasses were first prescribed
Age
enter age at which glasses were discarded
Age
Has the child ever had a squint?
1
Yes-squint still present
2
Yes-squint in past only
3
No-never had a squint
4
Don't know whether has had squint
At what age, if any, was squint first noted?
Age
enter age when disappeared
Age
What treatment, if any, was he/she given for the squint? (Ring all the codes which apply)
1
Never attended for medical advice
2
Medical advice given-'no treatment needed'
3
Patch over eye
4
Glasses
5
Eye exercises
6
Operation
7
Treatment was advised but not known what
8
Don't know if attended for treatment

HEARING

Has child always had good hearing in both ears?
1
Yes now and always in past
2
Yes now but has been poor in the past
3
No, reduced hearing in one ear only
4
No, reduced hearing in both ears
5
Don't know
please give the reason and diagnosis if known
Generic text
At what age, if any, was poor hearing first noted
Age
Has a hearing aid ever been worn?
1
Yes
2
No
3
Don't know

SPEECH

Has the child had any speech difficulty?
1
Yes, has it now
2
Yes, in past only
3
Never
4
Don't know
Please specify nature of difficulty
Generic text
Has the child ever had speech therapy?
1
Yes, has it now
2
Yes, in past only
3
No
4
Don't know

BLADDER/BOWEL CONTROL

Is the child completely dry at night?
1
Yes
2
No, wet in past month up to three times
3
No, wet in past month between 4 and 10 times
4
No, wet in past month 11 or more times
5
No, wet at night but don't know how often
6
Don't know if wet at night
Apart from any occasional mishap is the child completely dry by day?
1
Yes
2
No
3
Don't know
Does the child have normal bowel control, i.e does not soil?
1
Yes
2
No
3
Don't know

LATERALITY

Ask mother if the child is:
1
Left-handed
2
Right-handed
3
Mixed right and left
4
Don't know
'Which hand does your child write with?'
1
Left
2
Right
3
Don't know

ACCIDENTS AND INJURIES

Has the child ever received any of the following injuries? Scald/Burn
1
Yes, at home
2
Yes, at school
3
Yes, elsewhere
4
No, never
5
Don't know
state area affected.
Generic text
Has the child ever received any of the following injuries? Fracture of bone/skull
1
Yes, at home
2
Yes, at school
3
Road accident
4
Yes, elsewhere
5
No, never
6
Don't know
state area affected.
Generic text
Has the child ever received any of the following injuries? Flesh Wound requiring 10 or more stitches
1
Yes, at home
2
Yes, at school
3
Yes, road accident
4
Yes, elsewhere
5
No, never
6
Don't know
state area affected.
Generic text
Has the child ever received any of the following injuries? Accident causing unconsciousness
1
Yes, at home
2
Yes, at school
3
Yes, road accident
4
Yes, elsewhere
5
No, never
6
Don't know
for how long
Generic text
Has the child ever received any of the following injuries? Poison (Swallowed a poisonous or dangerous substance?)
1
Yes
2
No
3
Don't know
please give further details
Generic text
Has the child ever received any of the following injuries? Falls in water (In serious danger of drowning.)
1
Yes
2
No
3
Don't know
please give further details
Generic text

ROAD ACCIDENTS

Has the child ever been involved in a road accident causing injury requiring a stay in hospital overnight or longer?
1
Yes, once
2
Yes, twice
3
Yes, three or more times
4
No, never
5
Don't know
please give further details
Generic text

INFECTIOUS DISEASES

Has the child definitely had any of the following illnesses?
1
Measles
2
German Measles
3
Mumps
4
Chicken pox
5
Whooping cough
6
Scarlet fever
7
NONE OF ABOVE
Has the child had any of the following: (enter age)
1
Rheumatic fever
Age
Has the child had any of the following: (enter age)
2
Infectious Hepatitis
Age
Has the child had any of the following: (enter age)
3
Meningitis
Age
Has the child had any of the following: (enter age)
4
Tuberculosis
Age
Has the child had any of the following:
5
NONE OF THE ABOVE

PUBERTAL DEVELOPMENT

please ask the question 'Has your daughter had her first menstrual period, and if so at what age?'
1
No, not yet
2
Yes, before 5 years
3
Yes, between 5 and 8 years (inclusive)
4
Yes, aged 9 years
5
Yes, aged 10 years and up to 10 years and 6 months
6
Yes, aged 10 years and 6 months up to 11 years
7
Yes, aged 11 years and over
8
Yes, but don't know when
9
Don't know if child has had first menstrual period
please explain that the Study is interested in discovering whether the age at which a mother first menstruates is related to the rate of development of her child(ren). Then ask mother if she would consent to tell us the age at which her own menstrual periods began. Enter age in years. If no information leave blank
Age

MEDICAL CAUSES OF SCHOOL ABSENCE

How much time altogether has the child missed from school (or training centre, etc.) in the past year because of ill health or emotional disturbance? (Please state reason)
1
None, or less than one week in all
2
Over one week and up to one month in all
3
Over one month and up to three months in all
4
Over three months
5
Missed school, but don't know for how long
6
Don't know whether missed school
7
Does not attend school
Generic text
please indicate reason. If not applicable, leave blank; otherwise ring all relevant codes.
1
Colds, sore throats or ear infections
2
Bronchitis or chest infections
3
Asthma or wheeziness
4
Abdominal pain
5
Headaches
6
Infectious diseases
7
Accident or injury
8
Convulsions, fits or turns
9
Other causes (give details)
Other

ASTHMA or WHEEZY BRONCHITIS

Has the child ever had attacks of:
1
Asthma
2
Wheezy bronchitis
3
Neither of these
4
Don't know
what is the frequency of attacks?
1
At least once a week
2
Usually less than once a week but can expect one a month
3
At least one attack in past year but less frequently than one a month
4
Had attacks in past year but don't know how frequently
5
No attacks at all in past year but had attacks when younger
6
Other reply (give details)
Other

CONVULSIONS, TURNS OR FITS

Has the child had any of the following?
1
Major convulsion (or grand mal epilepsy)
2
Minor convulsion (or petit mal epilepsy)
3
Other, or mixed form of epilepsy
4
Fainting or blackouts
5
Other 'attacks' or turns
6
NO ATTACKS AT ALL
7
Don't know
Age when had most recent attack. Enter age in years at last birthday in boxes, e.g. for 9 yrs. enter 09
Age
Age in years when had first attack. If under 1 year enter 00
Age
Enter details of attacks below: Description
Generic text
Enter details of attacks below: Frequency
Generic text
Enter details of attacks below: Type and duration of treatment
Generic text

MEDICAL TREATMENT

Has the child had any medicaments from a doctor in the last three months (please include also maintenance treatments, e.g. anticonvulsants, insulin, etc.). Enter name of substance, where known opposite category listed Name of substance(s)
1
Liquid medicine
Generic text
Has the child had any medicaments from a doctor in the last three months (please include also maintenance treatments, e.g. anticonvulsants, insulin, etc.). Enter name of substance, where known opposite category listed Name of substance(s)
2
Tablets or pills
Generic text
Has the child had any medicaments from a doctor in the last three months (please include also maintenance treatments, e.g. anticonvulsants, insulin, etc.). Enter name of substance, where known opposite category listed Name of substance(s)
3
Inhalers
Generic text
Has the child had any medicaments from a doctor in the last three months (please include also maintenance treatments, e.g. anticonvulsants, insulin, etc.). Enter name of substance, where known opposite category listed Name of substance(s)
4
Injections
Generic text
Has the child had any medicaments from a doctor in the last three months (please include also maintenance treatments, e.g. anticonvulsants, insulin, etc.). Enter name of substance, where known opposite category listed Name of substance(s)
5
Other treatment
Generic text
Has the child had any medicaments from a doctor in the last three months (please include also maintenance treatments, e.g. anticonvulsants, insulin, etc.). Enter name of substance, where known opposite category listed
6
NOT HAD ANY TREATMENT
7
Don't know
for what reason was (were) the medicament(s) given? Ring all appropriate codes.
1
Convulsions or turns
2
Wheeziness or asthma
3
Diabetes
4
Other reason (specify)
Other

GENERAL HEALTH

Has the child suffered in the past twelve months from any of the following? Recurrent headaches or migraine
1
Yes
2
No
3
Don't know
Has the child suffered in the past twelve months from any of the following? Hay fever or allergic rhintis
1
Yes
2
No
3
Don't know
Has the child suffered in the past twelve months from any of the following? Recurrent vomiting or bilious attacks
1
Yes
2
No
3
Don't know
Has the child suffered in the past twelve months from any of the following? Recurrent abdominal pains
1
Yes
2
No
3
Don't know
Has the child suffered in the past twelve months from any of the following? Travel sickness
1
Yes
2
No
3
Don't know
Has the child suffered in the past twelve months from any of the following? Tics or habit spasms
1
Yes
2
No
3
Don't know
Has the child suffered in the past twelve months from any of the following? Recurrent mouth ulcers
1
Yes
2
No
3
Don't know
Has the child suffered in the past twelve months from any of the following? Recurrent throat and/or ear infections requiring treatment by a doctor
1
Yes
2
No
3
Don't know
Has the child suffered in the past twelve months from any of the following? Discharging ears (pus, not wax)
1
Yes
2
No
3
Don't know
Has the child suffered in the past twelve months from any of the following? Eczematous rashes
1
Yes
2
No
3
Don't know
Has the child suffered in the past twelve months from any of the following? Psoriasis
1
Yes
2
No
3
Don't know
Has the child suffered in the past twelve months from any of the following? Any heart complaint
1
Yes
2
No
3
Don't know
what have the parents been told about their child's heart?
Generic text
Has the child had any of the following operations: Removal of tonsils with or without adenoids
1
Yes
2
No
3
Don't know
Has the child had any of the following operations: Removal of tonsils with or without adenoids At what age?
Age
Has the child had any of the following operations: Removal of adenoids alone
1
Yes
2
No
3
Don't know
Has the child had any of the following operations: Removal of adenoids alone At what age?
Age
Has the child had any of the following operations: Circumcision (for girls leave blank)
1
Yes
2
No
3
Don't know
Has the child had any of the following operations: Circumcision (for girls leave blank) At what age?
Age
Has the child had any of the following operations: Repair of hernia
1
Yes
2
No
3
Don't know
Has the child had any of the following operations: Repair of hernia At what age?
Age
Has the child had any of the following operations: Removal of appendix
1
Yes
2
No
3
Don't know
Has the child had any of the following operations: Removal of appendix At what age?
Age
Has the child had a dental inspection in the past year?
1
Yes
2
No
3
Don't know
Were any of the following required? (Please indicate person responsible for treatment by ringing as appropriate) Filling
1
No
2
School Dentist
3
N.H.S. Family Dentist
4
Dentist in Hospital
5
Private (Fee paid) Dentist
6
Don't know
Were any of the following required? (Please indicate person responsible for treatment by ringing as appropriate) Extraction of teeth
1
No
2
School Dentist
3
N.H.S. Family Dentist
4
Dentist in Hospital
5
Private (Fee paid) Dentist
6
Don't know
Were any of the following required? (Please indicate person responsible for treatment by ringing as appropriate) Treatment to straighten teeth
1
No
2
School Dentist
3
N.H.S. Family Dentist
4
Dentist in Hospital
5
Private (Fee paid) Dentist
6
Don't know
Were any of the following required? (Please indicate person responsible for treatment by ringing as appropriate) Any false teeth made or crowning of teeth
1
No
2
School Dentist
3
N.H.S. Family Dentist
4
Dentist in Hospital
5
Private (Fee paid) Dentist
6
Don't know
Has the child ever been seen by or had specialist treatment from a medical/surgical specialist for any of the following? (Do not include treatment from a General Practitioner or Hospital Casualty Department). Eye disorder/vision/squint
1
Never
2
OUTPATIENT AT Hospital/clinic/at home/consulting rooms
3
INPATIENT Hospital/nursing home
4
Don't know
Has the child ever been seen by or had specialist treatment from a medical/surgical specialist for any of the following? (Do not include treatment from a General Practitioner or Hospital Casualty Department). Actual or suspected hearing loss
1
Never
2
OUTPATIENT AT Hospital/clinic/at home/consulting rooms
3
INPATIENT Hospital/nursing home
4
Don't know
Has the child ever been seen by or had specialist treatment from a medical/surgical specialist for any of the following? (Do not include treatment from a General Practitioner or Hospital Casualty Department). Nose, palate, ears (exclude hearing)
1
Never
2
OUTPATIENT AT Hospital/clinic/at home/consulting rooms
3
INPATIENT Hospital/nursing home
4
Don't know
Has the child ever been seen by or had specialist treatment from a medical/surgical specialist for any of the following? (Do not include treatment from a General Practitioner or Hospital Casualty Department). Asthma or wheezy bronchitis
1
Never
2
OUTPATIENT AT Hospital/clinic/at home/consulting rooms
3
INPATIENT Hospital/nursing home
4
Don't know
Has the child ever been seen by or had specialist treatment from a medical/surgical specialist for any of the following? (Do not include treatment from a General Practitioner or Hospital Casualty Department). Convulsions or fits
1
Never
2
OUTPATIENT AT Hospital/clinic/at home/consulting rooms
3
INPATIENT Hospital/nursing home
4
Don't know
Has the child ever been seen by or had specialist treatment from a medical/surgical specialist for any of the following? (Do not include treatment from a General Practitioner or Hospital Casualty Department). Enuresis
1
Never
2
OUTPATIENT AT Hospital/clinic/at home/consulting rooms
3
INPATIENT Hospital/nursing home
4
Don't know
Has the child ever been seen by or had specialist treatment from a medical/surgical specialist for any of the following? (Do not include treatment from a General Practitioner or Hospital Casualty Department). Disturbed behaviour, including emotional problems
1
Never
2
OUTPATIENT AT Hospital/clinic/at home/consulting rooms
3
INPATIENT Hospital/nursing home
4
Don't know
Has the child ever been seen by or had specialist treatment from a medical/surgical specialist for any of the following? (Do not include treatment from a General Practitioner or Hospital Casualty Department). Any operation (include any previously mentioned)
1
Never
2
OUTPATIENT AT Hospital/clinic/at home/consulting rooms
3
INPATIENT Hospital/nursing home
4
Don't know
We wish to know about all uses of hospital services by children, so please ask: Has the child ever been admitted to hospital overnight or longer including any occasions already mentioned?
1
Yes, before 7 years old only
2
Yes, after 7 years old only
3
Yes, both before and after 7 years of age
4
Never
5
Don't know
*
Other (please specify)
Other
how many times has the child been admitted to hospital? Please enter the total number of times in the boxes. If none, enter 00, for three times 03 etc.
How many

Please give details of these admissions.

Details including diagnosis or reason for admission or operation Age when admitted Name and address of hospital or nursing home
Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text
FIRST ADMISSION
SECOND ADMISSION
THIRD ADMISSION
FOURTH ADMISSION
FIFTH ADMISSION
If more than five times enter below:
Generic text

Now enter similar details concerning complaints which have received specialist treatment at OUTPATIENT hospital/clinic/domiciliary or private consulting rooms. (Only record first visits for each complaint, not follow-up visits).

Details including diagnosis or reason why seen by specialist Age when seen Name and address of hospital or private specialist
Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text
1
2
3
4
5
Name and address of child's General Practitioner:
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Since the child's 7th birthday has either parent (or parent substitute) suffered from chronic or serious disability or ill-health, including any hospital in-patient admission of two weeks or longer?
1
Yes, mother only
2
Yes, father only
3
Yes, both parents
4
No, neither parent
5
Don't know
6
Other answer (please specify)
Other
What is/was the condition? Mother
Generic text
What is/was the condition? Father
Generic text
How long was parent in hospital? Mother
Generic text
How long was parent in hospital? Father
Generic text
In what year was condition first apparent? Mother
Generic date
In what year was condition first apparent? Father
Generic date
What is the present state of health? Mother
Generic text